1. Inferior Alveolar Injection DHYG 149 PAIN CONTROL
Local Anesthesia
Inferior Alveolar Injection
DHYG 149 PAIN CONTROL

2. Welcome to Dental Analgesia
This is a self-paced learning module designed for the student wishing to prepare for or review the inferior alveolar injection technique. The inferior alveolar injection is the most common local anesthesia injection given. It is also a required performance for the Western Regional Examining Board Anesthesia Exam.

3. Navigating the program
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4. Overview Indications Mandibular anatomy
Inferior alveolar injection technique
Problems and corrections
Lab exercise
Basic injection technique

5. Indications Procedures involving multiple mandibular teeth
Procedures requiring lingual anesthesia

6. Mandibular Anatomy IA nerve and lingual nerve will be anesthetized
Evers, p. 76
Coronoid notch
Lingual nerve
IA nerve
Mandibular foramen
IA nerve and lingual nerve will be anesthetized
Target point is slightly above mandibular foramen
Coronoid notch is a guiding landmark

7. Inferior Alveolar Nerve
Evers, p. 71
Mental foramen
Mandibular foramen
Provides sensory innervation to:
Lower teeth on one side
Buccal bone from premolars to incisors
Soft tissue of lip and chin

8. Lingual Nerve Provides sensory innervation to: Lingual soft tissue
Anterior two-thirds of tongue
Mandibular foramen
Lingual nerve
Evers p. 72

9. Tissues Anesthetized Molars Premolars Canines Incisors
Lingual soft tissue
Tongue
Buccal soft tissue from mental foramen to midline
Evers, p. 87

10. Pterygomandibular Space
The soft tissues in the
vicinity of the injection
site form a space which
should be identified.
Target Point
Medial pterygoid muscle
Evers, p 72

11. Correct Needle Pathway
The barrel of the syringe should be over the opposite premolars. Bone should be contacted prior to depositing anesthetic.
Pterygoid raphe
Lingual nerve
Medial pterygoid muscle
Parotid gland
IA nerve

12. Incorrect Needle Pathway
The barrel of the syringe is lying over the incisors. This error directs the needle posterior to the target point, possibly resulting in trismus or facial nerve paralysis.
Pterygoid raphe
Lingual nerve
Medial pterygoid muscle
Parotid gland
IA nerve

13. Incorrect Needle Pathway
The barrel of the
syringe is lying over the
molars. This error
results in premature
contact of bone and
failure of anesthesia.
Pterygoid raphe
Lingual nerve
Medial pterygoid muscle
Parotid gland
IA nerve

14. Intraoral Landmarks The pterygoid raphe and the coronoid notch
form an imaginary
triangle. It is in
approximately the
center of this triangle
that the needle should
inserted.
Pterygoid raphe
Coronoid notch
Evers, p. 80

15. Insertion Point
Insert needle into the depression or imaginary triangle between the pterygoid raphe and the coronoid process 1 centimeter above the mandibular occlusal plane.
Evers. P 81

16. Target Point Advance needle until bone is contacted. Evers p 84

17. Deposition Aspirate in two planes Deposit at a rate of 1 ml/minute
You are ready to deposit the anesthetic. Don’t forget to:
Aspirate in two planes
Deposit at a rate of 1 ml/minute
Deposit 3/4 to 1 full cartridge

18. Failures of Anesthesia
Problem
Deposited below mandibular foramen
Deposited anterior to mandibular foramen
Deposited posterior to mandibular foramen
Correction
Reinject at height of triangle
Bring barrel of syringe
mesially over premolars
Bring barrel distally over premolars and contact bone
Review technique

19. Lab Exercise Remember: Practice this injection at your next lab.
Use 25 gauge needle for this injection
Look for intraoral landmarks
Visualize mandibular anatomy
Apply the basics of all injection
techniques

20. Basic Injection Technique
Review patient health history, medications and vitals
Determine injection technique based on procedure to be performed
Select appropriate anesthetic

21. Basic Injection Technique continued
Prepare syringe
use 25, 27, or 30 gauge needle
use aspirating syringe
Check flow of anesthetic
Position patient
Dry tissue
Apply topical antiseptic (optional)

22. Basic Injection Technique, continued
Apply topical anesthetic
Establish fulcrum
Stretch tissue
Keep syringe out of patient’s sight
Insert needle
Advance needle
Aspirate in two planes 11 12 13 14 15

23. Basic Injection Technique continued
Slowly deposit anesthetic
Withdraw syringe
Observe patient
Record injection and anesthetic in patient’s chart
Always communicate with patient throughout entire procedure 16 17 18 19 20

24. Acknowledgements
Hans Evers, Glenn Haegerstam, Introduction to Local Anesthesia, 2nd edition Mediglobe 1990
Margaret Ferenbach, Susan Herring, Illustrated Anatomy of the Head and Neck, W.B. Saunders 1996
Prof. Jill Torres, Oregon Institute of Technology, Department of Dental Hygiene